Noninvasive ventilation in status asthmaticus in children: levels of evidence

OBJECTIVE To evaluate the quality of available evidence to establish guidelines for the use of noninvasive ventilation for the management of status asthmaticus in children unresponsive to standard treatment. METHODS Search, selection and analysis of all original articles on asthma and noninvasive ventilation in children, published until September 1, 2014 in all languages in the electronic databases PubMed, Web of Science, Cochrane Library, Scopus and SciELO, located using the search terms: "asthma", "status asthmaticus", "noninvasive ventilation", "Bronchospasm", "continuous positive airway pressure", "child", "infant", "pediatrics", "hypercapnia", "respiratory failure" and the keywords "BIPAP", "CPAP", "Bilevel", "acute asthma" and "near fatal asthma". The articles were assessed based on the levels of evidence of the GRADE system. RESULTS Only nine original articles were located; two (22%) articles had level of evidence A, one (11%) had level of evidence B and six (67%) had level of evidence C. CONCLUSION The results suggest that noninvasive ventilation is applicable for the treatment of status asthmaticus in most pediatric patients unresponsive to standard treatment. However, the available evidence cannot be considered as conclusive, as further high-quality research is likely to have an impact on and change the estimate of the effect.